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Medical Myths

Plantar Fasciitis may be a common cause of foot pan … but it’s not the ‘sole’ cause.

When it comes to feet there is a medical truism: we all take them completely for granted – until they start to go wrong!

Complaints about foot and ankle pain are a daily presentation to any chiropractic clinic; particularly so at Yeovil Chiropractic Clinic, where we normally have a podiatrist (foot specialist) working alongside us (get well soon, Robin!).

Although the complaint itself may appear simple, the underlying causes can often be complex – did you know that a quarter of all the bones in your body are in your foot?To make matters worse, foot problems aren’t just caused by feet. They can also be the result of knee, hip and low back dysfunction and it’s important that any treatment takes this holistic approach.

Of the dozens of possible diagnoses, which can include congenital variants, neuromas, stress fractures, arthropathies, sprains, strains, bursitis, tendinopthies and fat pad pathologies we, in this country, appear to have a fixation with one condition – plantar fasciitis (pronounced ‘fash-ee-eye-tis’).

Of course plenty of people do present with plantar fasciitis – it’s a common condition in middle and old age. It’s caused by inflammation in the soft tissues that make up the arch of the foot – so if your pain isn’t in that area, it isn’t plantar fasciitis. The onset is usually quite sudden and associated with an obvious cause (change in footwear, walking barefoot, trekking across cobbled streets) and treatment should comprise two elements: symptom relief and determining the reason for the dysfunction and not just the cause of the onset – are the bones of the foot aligned properly? Are the muscles working properly? Is there damage to the ligaments? Are the legs functioning in a balanced and symmetrical manner? Are the nerves that control the feet working as they ought?

The symptoms are usually easy to control: medical treatment usually involves drugs to control the inflammation and advice about footwear (Crocks are our top tip) but if you want the treatment to be as effective as possible and minimise the chances of it coming back you need to ask the basic question: ‘why have I got this problem?’

…and if you feet aren’t giving you any grief, perhaps you should ask yourself ‘what can I do to keep it that way?’ – like many musculoskeletal conditions, the signs are normally there for the expert eye to detect before things actually start hurting: so are you taking your feet for granted?

Arthritis – Should I learn to live with it?

Arthritis is another of those words that mean different things to different people. To most, it means your joints have got a bit of wear and tear in them; to a specialist such as a rheumatologist or chiropractor, arthritis refers to a very specific group of much rarer inflammatory diseases of which rheumatoid arthritis and anklylosing spondylitis are probably the best known. Wear and tear – often referred to as ‘osteoarthritis’ – is a completely different disease process, which is why specialists prefer the term ‘degenerative joint disease’, or DJD for short.

So do you have DJD? If you’re over 50, then the answer is almost certainly “yes” – most commonly, it affects the joints that we use the most (thumbs, toes, backs and necks) or the ones that bear the most weight (hips and knees), particularly if you’re carrying extra poundage! So if you’ve got some swelling or stiffness in those joints, can you do anything about it?

For most of us, the good news is that pain in a joint with mild to moderate DJD is not, in my experience, a sentence to a lifetime on painkillers. Much like wear in a car tyre, it’s not just the annual mileage; whether the wheels are properly tracked is equally important. Similarly, the thing that often causes DJD to develop is not overuse but chronic dysfunction … and it is often the dysfunction that is actually causing the pain: get the joint working normally, and the pain goes away.

When chiropractic patient David was 56, he was told that his back pain was caused by spondylitis (DJD in the spine) and that there was nothing to be done. He had a 30-year history of a grumbling back, and an x-ray had shown some wear in the joints and discs at the base of his spine; however, examination revealed that his spine and pelvis had been twisted since picking up a heavy bag of compost in the 1970s and, once the joints had been put back to normal, the pain went away. Twelve years later, David still has the occasional chiropractic MOT, his back pain hasn’t come back … and the arthritis hasn’t progressed.

When arthritis is allowed to become severe, it can become painful it its own right: the joint wears away and large, sharp bony spurs form.At that point, surgery is often the only option.But why let it get to that stage?Most people get their cars serviced every year … when was the last time you had your joints serviced?

Is my shoulder frozen?

Have you ever had a shoulder joint that’s painful and restricted? The chances are you probably thought it was a ‘frozen shoulder’ – and the chances are you were probably wrong!

As with some of the previous terms we’ve discussed, such as sciatica and migraines, the problem lies in part with the difference between what you might mean by ‘frozen shoulder’ (it hurts and I can’t move it properly) and what a musculoskeletal specialist means by ‘frozen shoulder’ (very specifically, adhesive capsulitis) … and differentiating between the two is very important as they can have very different treatments and outcomes.

The shoulder is the most complicated joint in the body – in fact, it’s not one joint at all, it’s three joints plus the articulation between the shoulder blade and the top seven ribs.If it’s going to work properly, there are over 100 joints, muscles, ligaments and bursae that have to we working normally and integrate smoothly.Fortunately, of all the things that can go wrong, frozen shoulder (or adhesive capsulitis as we should call it from now on) is one of the less common.

So have you got adhesive capsulitis, or is it something else causing your shoulder pain?First of all, if you’re under 50 years old, it’s highly unlikely you’ve got adhesive capsulitis unless you have other health problems such as diabetes.If you’re over 50, there’s a simple test you can do: take off your shirt and lift your arms up sideways as far as they will go (which probably won’t be that far). If your shoulder blades swings out more quickly on the affected side, it could well be adhesive capsulitis … but, unfortunately, that won’t be all that’s wrong with your shoulder.

Although the mechanism that causes bits of the shoulder joint capsule to stick to other bits (adhesions) is complicated and poorly understood, it is almost invariably the case that it is triggered by something else going wrong with the shoulder, either one of those common conditions (tendinitis, impingement, bursitis etc) or by trauma such as a fall or particularly after a broken arm when the shoulder (and the rest of the upper limb) has been immobilised in a splint.

There are a number of treatments available – it’s a condition that chiropractors see every week, and their techniques are clinically proven to help restore mobility and reduce pain.Although, in skilled hands, steroid injections can often produce rapid relief, twenty years clinic experience has taught me this: if you haven’t got rid of the underlying condition that triggered the condition, it will rapidly return.

A true ‘frozen shoulder’ is a disabling condition that can rapidly become entrenched and chromic so, if you’re in the risk groups for adhesive capsulitis, my advice is to seek rapid care from a musculoskeletal specialist as soon as possible for any shoulder conditions that arise, no matter how innocuous they may seem initially – an ounce of prevention can be worth months of cure!

Gardening without the pain

The gardening season has started and, all over Britain, hundreds of chiropractors are rubbing their hands in glee as thousands of gardeners beat a hasty path to their doors to remove the pain from their shoulders, the ache from their backs and the cricks in their necks… but it needn’t be like that.

There is a myth that things need to hurt after a day in the garden, so accepted by gardeners and physicians alike that nobody bothers to do anything about it other than suffer in silence, reach for the pain killers or give up gardening – which is a shame because gardening is not just good for the soul but can be an excellence source of exercise, fresh air and sunlight, if done right.

Over the next few months, I will be showing you a few simple tricks to take the groan out of gardening without spending a fortune on equipment or hired help – in fact, the only equipment you need for the coming weekend is a piece of paper, a pencil and a ruler!

The trouble with most gardeners in they like to get straight to work and beaver away methodically at a task until it is finished, then stand back and admire their handiwork before hobbling on to the next job muttering about their backs aching from three hours bent double.

To avoid this, draw three columns on your paper: each column represents a 20 minutes slot, each line an hour. Work out what you need to do over the day and break the tasks into manageable chunks, then set an alarm on your watch or phone and stop when it goes off – the weeds won’t go away, they’ll wait until the afternoon… and don’t forget, if you’re #5stepping (and all gardeners should be) to programme in time for a couple of short walks and a drink or two.

If you avoid prolonged stress on your joints, muscles and ligaments, the simple truth is that they won’t hurt you and, at the end of the weekend, you can still stand back and admire everything you’ve achieved – without wincing once!

SCIATICA IS NOT THE ONLY CONDITION THAT'S A PAIN IN THE AR*S!

Sciatic pain is a common presentation to any chiropractic clinic and one of the commonest complications of low back pain… but, for every ten patients who think they have sciatica, probably only two or three actually do.

Part of the problem is that sciatica is used in everyday terms to describe pretty much any pain that runs down the leg; however, to a back specialist, such as a chiropractor, it refers very specifically to pain that arises from the sciatic nerve or its branches and it has a very specific pattern of distribution: down the buttock and the back of the thigh, often into the back of the calf and the sole of the foot. If it’s down the side or the front of your leg, then it’s not sciatica – but don’t worry, a chiropractor can probably tell you what it is !

Even if it is running down the back of your leg, sciatica still isn’t a definite diagnosis as sciatica isn’tthe only thing that can cause pain in the back of your leg. Identical symptoms can arise from the ligaments, joints, muscles and bones in your spine or buttock – in much the same way that pain from the heart refers to your left arm in angina.

Even if it is really sciatica, this is only a symptom – it is important to work out which of the dozens of possible causes is responsible for the pressure on the sciatic nerve, from benign causes such as tightness in surrounding muscles; through bulging or ‘slipped’ discs; to more sinister, less common causes, which require urgent investigation. Detailed orthopaedic and neurological testing can often pin point the site and nature of the fault; x-rays or magnetic resonance imaging can help confirm the diagnosis: chiropractors spend years learning how to interpret all of the evidence in order to arrive at a precise diagnosis (most middle-aged people have bulges in their discs; it doesn’t means that they’re necessarily the cause of the leg pain).

One of our patients (Dave) had suffered from worsening bouts of Sciatica for three years when he visited the clinic, “I was told that I would eventually need an operation,” he said, “but after 30 minutes of examination and testing, my chiropractor pinned the cause to a problem in my pelvis and put it right with a handful of treatments over a couple of weeks.”

So remember: Not all leg pain is sciatica; not all sciatica is due to disc problems and most disc problems

I’ve been told I’ve got … Migraines.

One of the commonest medical presentations is headaches, and the consultation often opens “I think I’ve got migraines” … but when is a migraine not a migraine?

Part of the confusion over migraine headaches is that they have developed a lay meaning, which is quite distinct from the medical one.“I’ve got a migraine”, has become a synonym for “I’ve got a really bad headache”.Medically, the severity of pain has got nothing to do with the diagnosis of ‘migraine’ – indeed, migraines may manifest without pain and instead involve visual disturbances, tingling or muscle weakness. The first and most important medical criterion is that the headache is one-sided; indeed, that’s how it got its name, from the Greek hemikrania, meaning ‘half a skull’.So, if your headache affects both sides, that’s good news as it's probably not a migraine (yes, it is possible to get a bilateral migraine but it's pretty rare).

So if the pain affects both sides of your head then you have bilateral cephalaligia – note the medical trick of saying exactly the same thing in long, preferably Latin words, it certainly makes you sound like you know much more than someone who merely says, 'my headache's on both sides". The most common cause of this is tension headache, which usually arises from the joints, muscles and ligaments of the spine, skull or jaw and usually responds well to the standard treatments offered at all four of our Chiropractic Clinics (www.mendmyjoints.com): mobilisation, spinal manipulative therapy, acupuncture, exercise and postural work.

If your headache is one-sided, then it still isn’t necessarily migraine. There are a number of other possible causes, and it can be important to rule these out. Chiropractors spend years training in neurology, orthopaedics, general medicine and diagnosis (I know, I've taught all four subjects to undergraduates) to be able to diagnose not just the type of headache but its underlying cause or causes – on the rare occasions it needs diagnostic imaging or hospital referral, this can be done within hours.

The commonest unilateral headache is fortunately benign. Cervicogenic headache, which seemingly arises from activation of the descendingnucleus of the fifth cranial nerve (which travels down the brainstem to the upper reaches of the spinal cord), often by tension in the lining of the spine, which anchors into the inside of the top three vertebrae: adjust the vertebrae, remove the tension and, unsurprisingly, the headache goes away!

If your headache is migranous, it will usually fall into one of two categories: either 'classic' migraine, which is accompanied by an aura (the sensory disturbance – usually visual – that precedes any head pain) or 'common' migraine, which is no less painful but lacks the accompanying neurological signs. The good new again is that chiropractic management is clinically proven to be effective in many cases of both forms of migraine.

Jayne had suffered from debilitating migraines for 15 years: “Medication wouldn’t touch them,” she said, “And they would knock me out for three days at a time.The first treatment session actually triggered a migraine – but that was the last one I ever had!”

But what happens when the headache is beyond the scope of any one practitioner? Often headaches – particularly migraines – can be multifactorial with contributions from diet, lifestyle, posture, stress, altered dentition, jaw clenching and hormones? I asked myself the same question a decade ago and started working with Mark Brickley, a functional orthodontist and Judith O'Hagan, a transpersonal psychotherapist, as well as our in-house Alexander Technique practitioner, Katrin Maclean, and Nutritional Therapist, Catherine White, in Somerset's own specialist multidisciplinary Headache Clinic (http://www.theheadacheclinic.co.uk), which has managed dozens of complex headaches that have defeated previous attempts at management.Charlotte travelled from London to attend the clinic, having already seen multiple consultants: "For the first time, my face and neck were examined to find the root cause. The clinic seemed to thrive on the challenge of diagnosing and treating my problem, working as a team. The first day I was headache free I had butterflies of excitement, just due to being pain free!"The clinic, which offers its diagnostic skills for free, has also has success in treating other causes of head and face pain such as Cluster Headaches, Episodic Headache and temporomandibular disorder (TMD).